Universität zu Köln

Huebner, Nicolai, Rasul, Sazan ORCID: 0000-0003-2898-3232, Baltzer, Pascal, Clauser, Paola, Grubmuller, Karl Hermann, Mitterhauser, Markus, Hacker, Marcus, Heidenreich, Axel, Rajwa, Pawel, Fajkovic, Harun, Shariat, Shahrokh F. and Grubmuller, Bernhard (2022). Feasibility and Optimal Time Point of [Ga-68]Gallium-labeled Prostate-specific Membrane Antigen Ligand Positron Emission Tomography Imaging in Patients Undergoing Cytoreductive Surgery After Systemic Therapy for Primary Oligometastatic Prostate Cancer: Implications for Patient Selection and Extent of Surgery. Eur. Urol. Open Sci., 40. S. 117 - 125. AMSTERDAM: ELSEVIER. ISSN 2666-1683

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Abstract

Background: Prostate-specific membrane antigen (PSMA) targeted molecular imaging using positron emission tomography (PET) has significantly improved the diagnosis and treatment of prostate cancer (PCA). Objective: To assess the feasibility and compare the diagnostic accuracy of [68Ga] Ga-PSMA-11 PET images taken at baseline, before the initiation of systemic treatment and preoperative images, using histopathology after cytoreductive surgery as reference. Design, setting, and participants: We identified 20 patients in our prospectively maintained database with primary oligometastatic PCA who underwent cytoreductive radical prostatectomy and superextended pelvic lymph node dissection after systemic therapy, who had baseline and preoperative [68Ga]Ga-PSMA-11 PET imaging available. Outcome measurements and statistical analysis: We performed a region-based analysis to determine the diagnostic accuracy of imaging, using pathology as a reference. Regions were predefined as prostate, internal iliac left/right, obturator left/right, external iliac left/right, common iliac left/right, and presacral. Results and limitations: Sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV), and diagnostic effectiveness were, respectively, 95.65%, 78.22%, 98.39%, 57.89%, and 83.00% for baseline [68Ga]Ga-PSMA-11 PET, compared to 56.52%, 98.05%, 88.30%, 89.66%, and 88.50% for preoperative [68Ga] Ga-PSMA-11 PET. On a receiver operating characteristic analysis, the diagnostic accuracy of baseline [68Ga]Ga-PSMA-11 PET with an area under the curve (AUC) of 0.87 (95% confidence interval [CI] 0.83-0.92) was significantly better than that of preoperative [68Ga]Ga-PSMA-11 PET after systemic therapy with an AUC of 0.77 (95% CI 0.70-0.85, p = 0.01). Conclusions: Baseline imaging, [68Ga]Ga-PSMA-11 PET has significantly better diagnostic accuracy, sensitivity, and NPV than images obtained preoperatively, in systemically pretreated patients. If a patient is suitable for local treatment and complete resection of the residual tumor is intended, [68Ga]Ga-PSMA-11 PET images taken prior to systemic therapy are significantly more accurate in selecting the relevant lymph nodes for resection. Patient summary: We found that prostate-specific membrane antigen positron emission tomography (PSMA-PET) imaging used early, before hormonal therapy or chemotherapy, provides more accurate information about the spread of the dis-ease, than if used immediately before surgery but after hormonal therapy or chemotherapy. Early use of PSMA-PET has the potential to improve therapy also at later stages of the disease. (c) 2022 The Authors. Published by Elsevier B.V. on behalf of European Association of Urology. This is an open access article under the CC BY license (http://creativecommons. org/licenses/by/4.0/).

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Huebner, Nicolai UNSPECIFIED UNSPECIFIED UNSPECIFIED Rasul, Sazan UNSPECIFIED orcid.org/0000-0003-2898-3232 UNSPECIFIED Baltzer, Pascal UNSPECIFIED UNSPECIFIED UNSPECIFIED Clauser, Paola UNSPECIFIED UNSPECIFIED UNSPECIFIED Grubmuller, Karl Hermann UNSPECIFIED UNSPECIFIED UNSPECIFIED Mitterhauser, Markus UNSPECIFIED UNSPECIFIED UNSPECIFIED Hacker, Marcus UNSPECIFIED UNSPECIFIED UNSPECIFIED Heidenreich, Axel UNSPECIFIED UNSPECIFIED UNSPECIFIED Rajwa, Pawel UNSPECIFIED UNSPECIFIED UNSPECIFIED Fajkovic, Harun UNSPECIFIED UNSPECIFIED UNSPECIFIED Shariat, Shahrokh F. UNSPECIFIED UNSPECIFIED UNSPECIFIED Grubmuller, Bernhard UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-691351
DOI:	10.1016/j.euros.2022.04.003
Journal or Publication Title:	Eur. Urol. Open Sci.
Volume:	40
Page Range:	S. 117 - 125
Date:	2022
Publisher:	ELSEVIER
Place of Publication:	AMSTERDAM
ISSN:	2666-1683
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language RADICAL PROSTATECTOMY; METASTASES; RECURRENCE Multiple languages Urology & Nephrology Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/69135